HIV/AIDS is the dominant health issue in Africa, where in many countries the human and social costs are devastating. Any deterioration in economic performance is likely to compound these costs and render countries less able to cope with the epidemic. However, conventional economic theories of growth argue that the impact of such an epidemic on the growth rate and level of income may be positive or negative. The analyses reported in this paper assess the impact of the HIV epidemic upon economic growth performance in 41 African economies between 1960 and 1998. The results indicate that for African countries where the prevalence of HIV is relatively low the impact of the epidemic conforms to ‘normal’ economic expectations. However, when the prevalence of the epidemic is relatively high the macroeconomic impact of the epidemic is unclear. Copyright © 2001 John Wiley & Sons, Ltd.